[Endoscopic mucosal resection for radical treatment of esophageal cancer]

Clinico-pathological results of patients with superficial esophageal cancer was reviewed to determine the indications of endoscopic mucosal resection (EMR) for esophageal cancer as a radical treatment and to evaluate clinical results of EMR. The analysis on eighty-seven cases with superficial esophageal cancer who underwent esophagectomy revealed no lymph node metastasis in any 0% of case with cancer confined to the lamina propria mucosae, 10% of cancer reaching the muscularis mucosae and 43% of cancer infiltrating the submucosa. These results suggested that the endoscopic mucosal resection should be indicated for patients with esophageal cancer confined to the lamina propria mucosae. The accuracy rate for estimating depth of invasion of mucosal cancer of the esophagus was 96%. We early established "the double channel technique" for resection of mucosal lesion of the esophagus with a major part of the submucosa, we used it for sixty-nine cases, and all were eventually discharged. Immediate complications of EMR were noted in 12.9% of all cases (mediastinal emphysema: 2.9%, ulcer bleeding: 10%) and the late complication in 7.2% (esophageal stricture due to scar formation: 5.8% and ulcer bleeding 5 days after EMR: 1.4%). All cases who developed stricture had mucosal defect over 3/4 the circumference. The cumulative 5-year survival rate of patients with esophageal mucosal cancer treated by EMR (86%) showed no significant difference from those treated by esophagectomy (83.2%). We to conclude that endoscopic mucosal resection is indicated for the patient with mucosal cancer confined to the lamina propria mucosae. One can expect an excellent prognosis by less invasive treatment than esophagectomy.